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Heart rate and pulse pressure at rest are major prognostic markers of early postoperative complications after coronary bypass surgery

^a Department of Thoracic & Cardiovascular Surgery and Vascular Medicine, Dupuytren University Hospital, Limoges, France
^b EA3174-IFR 175, University of Limoges, Limoges, France

Received 22 November 2007; received in revised form 20 January 2008; accepted 24 January 2008.

^_* Corresponding author. Address: Department of Thoracic & Cardiovascular Surgery and Vascular Medicine, Dupuytren University Hospital, 2, Avenue Martin Luther King, 87042 Limoges, France. Tel.: +33 555 05 63 71; fax: +33 555 05 63 84. (Email: victor.aboyans{at}unilim.fr).

Objective: There is substantial evidence to consider both heart rate (HR) at rest and pulse pressure (PP) as significant markers of cardiovascular prognosis in the general population. Despite this, neither of these two parameters has been taken into consideration in the design of modern coronary artery bypass risk prediction scores, and little data on their early postoperative prognostic value are currently available. We aimed to assess the predictive value of preoperative HR and PP in the 30-day postoperative period. Methods: We prospectively enrolled all patients referred to our institution for non-urgent coronary artery bypass grafting. We measured HR on ECG at admittance. Preoperative pulse pressure was obtained by the difference of the mean of three consecutive systolic and diastolic blood pressures. The primary outcome combined the 30-day postoperative mortality, myocardial infarction (new Q-waves on ECG or Troponin-I >20 µg/l) and stroke or transient ischemic attack. The secondary outcome corresponded to clinical events only (stroke or death). Statistical analysis was performed by usual methods. Results: We enrolled 1022 patients (age 66.9 ± 9.2 years). Those meeting the primary outcome (n = 146) had a significantly higher HR (69.9 ± 14.3 bpm vs 64.9 ± 13.2 bpm, p < 0.0001) and a higher proportion presented a PP >70 mmHg (17.1% vs 10.2%, p < 0.03). After adjustments for age, gender, systolic blood pressure, preoperative beta-blocker therapy, left ventricular ejection fraction <0.40, unstable cardiac status, redo surgery, peripheral arterial disease, renal failure, and combined vascular surgery, both HR (OR = 1.17 per 10 bpm, p < 0.03) and PP >70 mmHg (OR = 1.99, p = 0.03) remained significant risk predictors. Similar results were found when considering only clinical events. Conclusion: This prospective study highlights the usefulness of HR and PP as preoperative risk markers in CABG candidates.

Key Words: Heart rate • Pulse pressure • Coronary artery disease • Surgery • Prognosis